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Peer-reviewedCC BYBJC reports

The Cost of Uncertainty: A Microcosting Analysis of the Cancer of Unknown Primary Diagnostic Pathway.

  • Laura Spurgeon1,2
  • Claire Mitchell3
  • Alicia-Marie Conway3,4,5
  • Natalie Cook3,4
  • Sean P Gavan6
6 affiliations
  1. 1Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK. [email protected].
  2. 2Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. [email protected].
  3. 3Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
  4. 4Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
  5. 5National Biomarker Centre, Paterson Building, Manchester, UK.
  6. 6Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
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Abstract

Background

Cancer of Unknown Primary (CUP) is a heterogeneous group of cancers for which a primary site cannot be identified. The diagnostic pathway is often protracted and resource-intensive, with little known about the costs involved. The primary aims of this study were to (a) determine time-to-treatment-decision (pathway duration) and (b) estimate resources incurred and direct healthcare costs within the UK's diagnostic pathway.Methods

A microcosting analysis was conducted on 370 patients with CUP. For relevant context, a comparison cohort of 216 patients with stage IV cholangiocarcinoma (CCA) was selected. Pathways were mapped from the first cancer-related investigation until treatment decision. Analyses estimated pathway duration and cost, and explored the significance of prognostic variables on the CUP pathway.Results

Median pathway duration in CUP was 40% longer than CCA (2.8 months vs 2.0 months, respectively, p < 0.001). Mean per-patient cost of the CUP pathway was 62% higher than CCA (£3902 vs £2403 respectively, p < 0.001). Performance status 0-1 and squamous-cell histology were predictive of higher costs in CUP.Conclusions

Direct healthcare costs were significantly higher in CUP. Improvements are required to rationalise investigations and facilitate patients receiving treatment in an appropriate timeframe.

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Cite

BibTeXRIS
BibTeX
@article{spurgeon2026cost,
  title = {{The Cost of Uncertainty: A Microcosting Analysis of the Cancer of Unknown Primary Diagnostic Pathway.}},
  author = {Laura Spurgeon and Claire Mitchell and Alicia-Marie Conway and Natalie Cook and Sean P Gavan},
  journal = {BJC reports},
  year = {2026},
  month = oct,
  doi = {10.1038/s44276-026-00252-8},
  url = {https://europepmc.org/article/MED/42919843},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - The Cost of Uncertainty: A Microcosting Analysis of the Cancer of Unknown Primary Diagnostic Pathway.
AU  - Laura Spurgeon
AU  - Claire Mitchell
AU  - Alicia-Marie Conway
AU  - Natalie Cook
AU  - Sean P Gavan
PY  - 2026
DA  - 2026/10/23
JO  - BJC reports
DO  - 10.1038/s44276-026-00252-8
UR  - https://europepmc.org/article/MED/42919843
AB  - Background  Cancer of Unknown Primary (CUP) is a heterogeneous group of cancers for which a primary site cannot be identified. The diagnostic pathway is often protracted and resource-intensive, with little known about the costs involved. The primary aims of this study were to (a) determine time-to-treatment-decision (pathway duration) and (b) estimate resources incurred and direct healthcare costs within the UK's diagnostic pathway.Methods  A microcosting analysis was conducted on 370 patients with CUP. For relevant context, a comparison cohort of 216 patients with stage IV cholangiocarcinoma (CCA) was selected. Pathways were mapped from the first cancer-related investigation until treatment decision. Analyses estimated pathway duration and cost, and explored the significance of prognostic variables on the CUP pathway.Results  Median pathway duration in CUP was 40% longer than CCA (2.8 months vs 2.0 months, respectively, p < 0.001). Mean per-patient cost of the CUP pathway was 62% higher than CCA (£3902 vs £2403 respectively, p < 0.001). Performance status 0-1 and squamous-cell histology were predictive of higher costs in CUP.Conclusions  Direct healthcare costs were significantly higher in CUP. Improvements are required to rationalise investigations and facilitate patients receiving treatment in an appropriate timeframe.
SN  - 2731-9377
ER  -